If appropriate, based on a person’s history/symptoms, a biomechanical assessment will be performed to see if a person may require insoles/orthotics/shoe inserts to help in relieving symptoms and strain on joints/muscles/tendons/ligaments of the lower limb/pelvis/spine, to optimise a person’s function and comfort. This may help with problems such as pain/dysfunction associated with many conditions including:
Flat Feet/Pronated Feet
Osteoarthritis/Pain in any of the joints of the toes/foot/ankle/knee/hip/spine
ITB (iliotibial band strain)
Appropriate Therapeutic Exercises will be given in conjunction with insoles to help improve the function of the foot/ankle complex/lower extremity strength and flexibility/balance mechanisms as appropriate for an individual.
Many times a person may only require arch support suitable to their arch profile (low/medium/high arch profile -called the longitudinal arch) to help to optimise the alignment and function of their foot and lower limb.
Sometimes in addition some extra support may be required to the rear foot &/or forefoot to achieve better alignment and support. Sometimes a person may need extra support to the arch behind the balls of the toes (transverse arch) to help take increased stress off the balls of the toes (often evidenced by the accumulation of hard skin under the balls of the toes, and possibly corns on the top of the toes).
Sometimes the joint at the base of the big toe may be very stiff (Hallux Rigidus). This can really interfere with walking at the part of gait where you are going up on your toes, at the end foot contact to the floor before that foot comes off the ground to go into the swing phase, causing pain at the base of the big toe and possibly decreasing stride length. Different accommodations to the insole can help this problem. Sometimes adding more support behind the balls of the toes to the transverse arch helps, or incorporating a cut out under the joint creating a small depression allows for more pain-free movement here. Sometimes more support is required under this joint to decrease movement and stress at this joint.
Occasionally a heel lift may be required to take strain off of an achilles tendinitis during the initial healing phase, or if there is a true leg length difference to help equalise leg length. I find this is quite rare. Often there can be an apparent leg length difference, as a consequence of a twist or rotation of the pelvic bone on one side. If a pelvic bone is twisted forwards on one side, it can make that leg appear to be longer than the opposite leg. If a pelvic bone is twisted backwards on one side, it can make that leg appear to be shorter than the other leg. When there appears to be a leg length difference I would always assess for a twist of the pelvis and if present treat that and then reassess leg length. Then if there is still a leg length difference present this can be accommodated for with an appropriate heel raise, but again I rarely find this to be the case.
I aim for the least bulky corrections needed to help maximise comfort and compliance in using/wearing any accommodative inserts/insoles. I also aim for the least costly but effective inserts/insoles. Sometimes just more supportive/appropriate shoe-wear is all that is required. Frequently off the shelf devices are totally appropriate and these are very reasonably priced. There is a huge range of good off the shelf devices/insoles available from orthotic companies that suit different situations. Sometimes a customised insole is required where a cast is made and along with the biomechanical assessment the appropriate insole is prescribed and ordered from on orthotic company. I always aim to keep the solution where required effective and at a very cost-efficient fee, not adding any profit margin, just covering my cost. The orthotic companies I deal with also offer a big range of shoe-wear that suits an individual’s foot and their activities, and these can be ordered and again I pass on the cost that I pay for them.